Emotional variables associated with treatment outcome in veterans with chronic PTSD

Moira P. Ripley (2003)

For many veterans, traumatic military experience has created a complex picture of posttraumatic stress disorder (PTSD) that is chronic and treatment resistant, resulting in significant psychological and psychosocial impairment. Historically, specialized treatment for PTSD has been a priority within the Veterans Administration (VA). However, disappointing results from recent program effectiveness studies have led to closer scrutiny of program components. Some researchers and clinicians have recommended a shift in treatment focus from intense trauma exploration to more skills training and problem-solving approaches. Improved patient selection criteria have been sought, particularly for trauma-focused treatments. This retrospective study investigated whether pretreatment emotional functioning, as measured by scores on the Toronto Alexithymia Scale (TAS), was associated with differential response to trauma exposure versus skills-focused group treatment for PTSD. It examined treatment response in a final sample of 40 combat veterans who completed specialized PTSD programs at the White River Junction VA Medical Center between 1996 and 1999. Clearly defined differences in treatment focus made comparison between programs possible. Standardized assessments were conducted while program applicants were on the waiting list, at intake, and at four months posttreatment. Treatment outcome data reporting veterans' PTSD symptoms, violence perpetration, and drug and alcohol use were contrasted for the 2 types of group treatment For the sample as a whole, PTSD symptoms and violent behavior improved, while alcohol abuse worsened. Trauma Exposure was more effective than skills-focused treatment, with 6 veterans (40%) of the trauma exposure group demonstrating clinically significant improvement at four months posttreatment. The TAS variable was unrelated to outcome. Clinical implications of the findings are discussed, with recommendations for future research.